Open globe injuries: factors predictive of poor outcome
Open globe injuries: factors predictive of poor outcome
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DOI：
10.1038/sj.eye.6702099
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发表时间：
2006-12-01
期刊：
影响因子：
3.9
通讯作者：
Leatherbarrow, B.
中科院分区：
文献类型：
--
作者：
Rahman, I.;Maino, A.;Leatherbarrow, B.
目的尽管在眼部和眼眶成像、器械、材料和外科手术方面取得了进展，开放性地球仪损伤的处理仍然是一个棘手的难题。在这项回顾性研究中，我们确定了一系列的开放性地球仪损伤的临床特征和结果提出了一个主要的英国centr.Method手术部门的记录进行了审查，以确定所有的患者谁经历了修复开放性地球仪损伤从1998年1月1日至2003年1月1日在曼彻斯特皇家眼科医院。检查病例记录以确定人口统计学数据、损伤机制、酒精/药物的影响和损伤位置。结果115例开放性地球仪损伤患者中，有107例可供复习。锐器伤眼占71/107（66%）例，钝器伤眼占30/107（28%）例。6例（6%）损伤原因不明。在我们的107例开放性地球仪损伤中，二次眼球摘除率为13/107（12%）。与最终眼球摘除相关的重要风险因素包括相对传入瞳孔缺陷（P < 0.001），无红色反射（P < 0.001），眼睑撕裂（P < 0.02），钝性损伤机制（P < 0.02），初始VA低于6/60结论通过回顾性研究，我们已经确定了几个可能有助于临床医生决定一期修复预后价值的因素。钝性损伤伴附件损伤、初始视力差、RAPD或视网膜脱离、红反射缺失与随后眼球摘除率显著增高相关。
Objective Despite advances in ocular and orbital imaging, instrumentation, materials, and surgical procedures, the management of open globe injuries continues to pose difficult management dilemmas. In this retrospective study, we identify clinical characteristics and outcome of a series of open globe injuries presenting to a major UK centre.Method Operating department records were reviewed to identify all patients who had undergone repair of an open globe injury from 1 January 1998 to 1 January 2003 at the Manchester Royal Eye Hospital. Case notes were examined to determine demographic data, mechanisms of injury, influence of alcohol/drugs, and location of injury. The Snellen visual acuity on presentation and initial clinical signs were recorded.Results In total, 115 cases of open globe injury were identified of which 107 cases notes were available for review. Injury to the eye with a sharp object accounted for 71/107 (66%) cases and blunt mechanisms for 30/107 (28%) cases. In six (6%) cases the cause of injury was unknown. The rate of secondary enucleation in our series of 107 open globe injuries was 13/107 (12%). Significant risk factors on presentation associated with eventual enucleation included relative afferent pupillary defect (P < 0.001), absence of a red reflex (P < 0.001), presence of a lid laceration (P < 0.02), a blunt mechanism of injury (P < 0.02), and an initial VA worse than 6/60 (P = 0.03).Conclusion From this retrospective study, we have identified several factors that may aid the clinician in deciding on the prognostic value of primary repair. Blunt injuries associated with adnexal trauma, with poor initial visual acuity, the presence of an RAPD or retinal detachment, and the absence of a red reflex are associated with a significantly higher rate of subsequent enucleation.